Provider Demographics
NPI:1821295536
Name:MORGAN, ELYSE (PHD)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 14TH ST
Mailing Address - Street 2:#505
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5310
Mailing Address - Country:US
Mailing Address - Phone:303-442-8770
Mailing Address - Fax:
Practice Address - Street 1:1919 14TH ST
Practice Address - Street 2:#505
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5310
Practice Address - Country:US
Practice Address - Phone:303-442-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical